Een interessante reactie van de International Community of Women Living with HIV/AIDS die waarschuwt tegen een te simplistische benadering van ABC:

www.icw.org/tiki-download_file.php?fileId=137

8 REASONS WHY ABC DOES NOT WORK!
– HIV positive women explain why the ABC approach to HIV prevention and sexual and reproductive health for all women does not work.

The ABC approach to safer sex, promoted by the current USA administration in much of the world, stands for ‘Abstain, Be faithful, or use Condoms’. In many cases American government-funded projects are pressured into promoting abstinence-only programmes for young people and leaving out the ‘C’. HIV Positive Women say ABC Asks the Impossible, Blames Women, Costs Lives Dr Alice Welbourn, ICW’s chair, explains that the ABC approach to HIV prevention is simplistic, gender insensitive and implicitly lays the blame on those of us who fail to follow its message. A simplistic ABC message is actually highly damaging to HIV prevention work and further stigmatises HIV positive people.

1) The ABC approach is extraordinarily difficult for most people to follow. Just imagine going home after this conference. Your long-term partner greets you with these words: ‘Darling, I don’t think we should have sex any more’, or ‘Have you been faithful to me while you’ve been away?’ or ‘I’d like us to start using condoms every time we have sex for the rest of our lives.’ What would your reaction be? ‘OK dear, that’s just fine by me?’ Or would you wonder ‘What’s been going on while I’ve been away?’ Or perhaps you’d think your partner was suspicious of you?

‘I had an arranged marriage in 1995. After that my husband told me he’d had sex before we were married but he promised to be faithful. I trusted him.’ (HIV positive woman from India)

2) The ABC approach ignores gender issues and does not understand the reality of choice. Most women in the world are economically dependent on their husbands. They cannot afford to risk losing their children and home. For these women, it would be next to impossible to tell their husbands that they want to abstain from sex, or use a condom. ABC messages imply that all women have choice over how, where, and when they have sex with their partners. This is untrue, and such assumptions only serve to undermine women’s self esteem. Similarly, poor women – single or with a partner – may need to sell sex for money or goods. If their only choice is between getting some money in order to feed their children, or insisting on sex with a condom, they have no choice.

‘In my culture, talking about sex isn’t really accepted. And I was afraid I would be rejected if I told my husband I was positive.’ (HIV positive woman from Thailand)

3) The ABC approach ignores many other inequalities and realities which affect how people make decisions about sexual practice, such as poverty, workplace inequities, and attitudes in schools and communities. The so-called successes of ABC in countries such as Uganda are in fact due to varied approaches to prevention on many different levels. Promoting the care, support, respect and dignity for people living with HIV/AIDS has been rated as important a strategy for HIV prevention as abstinence or being faithful.

4) The importance of parenthood. The ABC message does not adequately reflect the role that parenthood plays in most of the world, where motherhood and fatherhood are central to adulthood. Once more, abstaining from sex or using condoms is not an option which people are prepared to consider, since they do not meet people’s more immediately felt needs – in this case to welcome pregnancy.

5) Only you? Being faithful presents a puzzle. No matter how much a woman is faithful to her partner, if the latter is having unprotected sex with others, that woman is at risk. In many societies it is culturally acceptable for men to have sex with multiple partners without their wives’ knowledge or consent; and culturally unacceptable for women to discuss such matters with their husbands. Once more, this message is beyond the choice of women, who have no power to determine their husbands’ actions.

‘We are getting HIV from our husbands; we are being monogamous and we are still getting HIV.’ (A Young HIV positive woman from South Africa)

6) Men too… There are huge problems for many men too. For instance, if a man has had unsafe sex with someone else and fears that he may be infected, he may wish to use condoms in future with his wife. But if she – or the extended family – wants him to have children and also associates condoms with the sex trade, how can he start using them to protect her?

7) Abstinence for young people? Despite pressures from the USA to promote pre-marital abstinence campaigns, research by Christian Aid in South Africa and others elsewhere shows that these can do more harm than good in depriving young people of essential, non-judgmental information, support and services. Some research also indicates that a significant number of young people are confused by what exactly ‘abstinence’ means; some have interpreted it as meaning anal sex is safe. If young people ‘fail’ to keep their virginity pledge, they are also less likely to use condoms and feel it is their fault if things go wrong for them.

‘We have to leave aside our faith in fidelity. No, no. If we are to live sexually, or make love, let’s use our condoms! Let’s not blame anybody. Making love is the responsibility of two.’ (An HIV positive woman from Panama)

8) Safer Sex? The ABC approach brushes aside decades of dedicated health promotion work around safer sex, which emphasises the safety and pleasures of non-penetrative sex, as well as the use of condoms in penetrative sex. ABC ignores and refuses woman-friendly safer sex messages which also address women’s need to gain the confidence and power to say ‘No’ to unwanted sex, and ‘Yes’ to appropriate safer sex activity.

‘I learned about how to say no. I learned to value my body. I learned to be sexually creative and protect the one who loves me as well as myself.’ (HIV positive woman from Zambia

As HIV positive women, we say: The ABC message seeks to impose a particular world view of the relations between men and women, and about sexuality, on every one else. This is far too simplistic AND it will not work. All humanity deserves more respect, more support, more encouragement in the creation of honest, open, fully informed and trusting relationships. Do NOT be fooled by over-simplified messages which mask lived realities.

‘HIV is something we all live with. We must share that experience. We must lobby and get the message across that we are women with rights. Let’s continue the struggle and together we can succeed.’ (HIV positive woman from Nicaragua)

ICW offers in depth knowledge, experience, and analysis of reproductive and sexual health. As HIV positive women, we have been working for the past 12 years for the empowerment of all women, for our own rights, and for life affirming approaches to halt the AIDS pandemic. When will the world start to listen to our experiences?

ICW’s Alternative ABC message: Assert Yourself, Be Open, Communicate!
Judith Reijnierse () - 13|03